Food for Thought

[Noyac]

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We debate the pros and cons of being employed vs not on this site from time to time. But if your group is receiving a subsidy of any sort, you are essentially employed, no?

The hospital at any time can decide to go in another direction to save money.

 

[deleted126335]

We debate the pros and cons of being employed vs not on this site from time to time. But if your group is receiving a subsidy of any sort, you are essentially employed, no?

The hospital at any time can decide to go in another direction to save money.

Disagree. We had much more control and autonomy as a private group with a fat subsidy as compared being directly employed as opposed to getting the same package as employees.

 

[Noyac]

Disagree. We had much more control and autonomy as a private group with a fat subsidy as compared being directly employed as opposed to getting the same package as employees.

True
But if the admin wants to cut costs, you could find yourself out on your keister.

 

[eagle0990]

I think it is a subtle difference..... and likely only psychologically.

Any group that receives a subsidy from its hospital partner is always at risk for losing the contract (especially if someone else is willing to take less). It just depends on how willing/able the group is to reduce or remove the subsidy.

Whether you are an employed physician or in a group that recieves a subsidy you answer to a "higher power". As an owner/shareholder in a group you just feel more comfortable about bending over for that higher power.

The perception of greater control is powerful though.

 

[deleted171991]

I think it is a subtle difference..... and likely only psychologically.

Any group that receives a subsidy from its hospital partner is always at risk for losing the contract (especially if someone else is willing to take less). It just depends on how willing/able the group is to reduce or remove the subsidy.

Whether you are an employed physician or in a group that recieves a subsidy you answer to a "higher power". As an owner/shareholder in a group you just feel more comfortable about bending over for that higher power.

The perception of greater control is powerful though.

Let's not mention the reality of a greater income.

 

[deleted126335]

True
But if the admin wants to cut costs, you could find yourself out on your keister.

They didn't want to throw us out...They wanted us to work for less...They employed us and turned several former decent workers into civil servants...They spent even more...We had lots more protection and autonomy and flexibility on how to spend the dollars and save on taxes as a private group. It wasn't just perception.

 

[eagle0990]

Let's not mention the reality of a greater income.

I don't disagree that greater income is possible.....

but higher financial support = deeper bend over

 

[deleted87051]

It also depends on the amount of the subsidy. We used to get no subsidy. When we became a level 1 trauma center about 10 years ago we negotiated a stipend to sleep in house rather than at home. Still it represents less than 5% of my income for sleeping in house once or twice a month. I'd be happy to give that up and sleep at home every night again.

 

[sevoflurane]

Nimbus makes a good point. Assuming that the hospital can get it done for less is sometimes a huge assumption.
It depends on the the services provided, location, and number of staff necessary to keep the hospital running.

Example:
What happens when said hospital goes out and gets a bid that ends up being X-million higher than the current set up (with subsidies)?
Said hospital shot themselves in the foot as they have now demonstrated a higher overal worth of the group.

Depending on the size, some hospitals couldn't afford to force a group to become hospital employees. This can be a big undertaking with possibly less upside potential.

Say you run a large group (80 FTEs) that has a peds service/cardiac and TEE service/ICU staffing/regional service/chronic pain service/overnight trauma service/overnight OB service all of which are heavily used at multiple hospitals in the area... well then these services become an important part of the "package" that the group is offering for compensation (subsidies).

Not easy to find a big group that covers everything from the sick 600 gm'er coming down from the neonatal ICU to being able to handle multiple massive trauma scenarios to doing heavy cards and pain plus an OB service that has 5000 deliveries a year. The group definitely has negotiating power under theses circumstances.

The last thing that the hospital wants is for the group to walk and operations to come to a halt.

 

[sevoflurane]

When surgical operations come to a halt... the board will likely start looking for new person to run the hospital.

This of course is an extreme scenario, but people like to keep their jobs in the end.

 

[B-Bone]

PP groups frequently run much more "lean and mean" than employed groups. In a PP group, you can work harder/smarter and make more money/get more time off. When you're hospital-employed and the bottom line doesn't directly impact your income, you have less incentive to bust your butt. This has been demonstrated locally when a high-functioning PP group became employed by the hospital. Used to hump to get cases done and get the F out of the hospital with a nice paycheck. Hospital made the (incorrect) assumption they would get the same production from employed physicians, while making a profit off them. Tried to cut salaries/benefits/vacation. This did not pan out in their unpopular midwest location. After some attrition, they have found an equilibrium where they have to pay big bucks (like 650k) with good benefits/vacation (12 weeks) and low acuity (supervising 2 rooms) just to keep the place running. Anesthesia went from a no-cost department (contracted with the PP group) to a huge money pit for the hospital. This is going on about 10 years at this point.

 

[GA8314]

We debate the pros and cons of being employed vs not on this site from time to time. But if your group is receiving a subsidy of any sort, you are essentially employed, no?

The hospital at any time can decide to go in another direction to save money.

Yes, but it depends on the terms. It also depends on the administration as you well know. If they want 24/7 OB coverage then they will have to pay for it. It's a business decision. But, if that service is not financially viable, and the hospital still requires it, then they will pay a subsidy.

But, yeah, of course subsidies make one vulnerable. Fortunately, I'm sensing that word has gotten around that the national groups who come in and attempt to poach your contract based in large (or total) part based on subsidy reduction or elimination has turned out to be a big ruse. I've seen several such situations, and they are still paying loads in Locums, and then going back to Administration a year or two later asking for part of that subsidy back......

My sense is that word gets around. Weak groups not infiltrated very well into the hospital system are of course more vulnerable.

 

[Leinie]

PP groups frequently run much more "lean and mean" than employed groups. In a PP group, you can work harder/smarter and make more money/get more time off. When you're hospital-employed and the bottom line doesn't directly impact your income, you have less incentive to bust your butt. This has been demonstrated locally when a high-functioning PP group became employed by the hospital. Used to hump to get cases done and get the F out of the hospital with a nice paycheck. Hospital made the (incorrect) assumption they would get the same production from employed physicians, while making a profit off them. Tried to cut salaries/benefits/vacation. This did not pan out in their unpopular midwest location. After some attrition, they have found an equilibrium where they have to pay big bucks (like 650k) with good benefits/vacation (12 weeks) and low acuity (supervising 2 rooms) just to keep the place running. Anesthesia went from a no-cost department (contracted with the PP group) to a huge money pit for the hospital. This is going on about 10 years at this point.

Are you hiring? Sign me up!

 

[deleted171991]

I don't disagree that greater income is possible.....

but higher financial support = deeper bend over

There is so much bending over, even without stipends. A group that relies on a single hospital (system) will kiss so many butts, surgical, administrative, nursing, you name it.

I would prefer to bend over as a partner rather than as an employee. Nowadays, anesthesia bends over everywhere.